1841495116 NPI number — BORIS KARPOVSKY, M.D., LLC

Table of content: (NPI 1841495116)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841495116 NPI number — BORIS KARPOVSKY, M.D., LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BORIS KARPOVSKY, M.D., LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841495116
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
199 COOLIDGE AVE
Provider Second Line Business Mailing Address:
UNIT 313
Provider Business Mailing Address City Name:
WATERTOWN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02472-1557
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-926-5268
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
280 WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
BRIGHTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02135-3511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-789-5333
Provider Business Practice Location Address Fax Number:
617-789-4457
Provider Enumeration Date:
06/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KARPOVSKY
Authorized Official First Name:
BORIS
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
617-926-5268

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  43860 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207RH0003X , with the licence number: 43860 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: J10609 . This is a "BCBS OF MASS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 646734 . This is a "HARVARD PILGRIM HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3073424 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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